Provider Demographics
NPI:1568538692
Name:JEFFREYS, LARISA (PMHNP)
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:JEFFREYS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 NW THURMAN ST.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2579
Mailing Address - Country:US
Mailing Address - Phone:503-227-0975
Mailing Address - Fax:971-339-4849
Practice Address - Street 1:2340 NW THURMAN ST.
Practice Address - Street 2:SUITE 202
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2579
Practice Address - Country:US
Practice Address - Phone:503-227-0975
Practice Address - Fax:971-339-4849
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200350004NP363LP0808X
OR200350004363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health